Validación argentino-chilena de la versión en español del test Addenbrooke's Cognitive Examination III para el diagnóstico de demencia / Argentinian/Chilean validation of the Spanish-language version of Addenbrooke's Cognitive Examination III for diagnosing dementia

INTRODUCCIÓN: El Addenbrooke's Cognitive Examination III (ACE-III) es una adaptación del test de cribado ACE, la cual ha demostrado tener una alta sensibilidad y especificidad para detectar disfunción cognitiva en pacientes con demencia y otras patologías neurológicas y psiquiátricas. Si bien el ACE-III ya ha sido validado en castellano (España), este no ha sido validado en Latinoamérica. El objetivo del presente estudio fue validar el ACE-III en una población argentina y chilena. MÉTODOS: Se evaluó un grupo de pacientes con enfermedad de Alzheimer (n = 70), un grupo de pacientes con la variante conductual de la demencia frontotemporal (n = 31) y un grupo control (n = 139) con la versión en español del ACE-III; reclutados en centros médicos de ambos países. RESULTADOS: La versión argentina-chilena del ACE-III presentó una buena consistencia interna (alfa de Cronbach = 0,87). Se hallaron diferencias significativas en los valores totales del ACE-III entre el grupo control y el grupo de demencias (p < 0,05) y entre ambos grupos de demencia (p < 0,05). Con un punto de corte de 86, el 98,6% de los pacientes con DTA, el 83,9% de pacientes con variante conductual de la demencia frontotemporal y el 84,2% de los controles fue correctamente clasificado. CONCLUSIONES: El presente estudio ha demostrado que el ACE-III continúa siendo una herramienta útil para la detección de la disfunción cognitiva en la demencia

BACKGROUND: The Addenbrooke's Cognitive Examination III (ACE-III), an adaptation of the ACE cognitive screening test, has been demonstrated to have high sensitivity and specificity in detecting cognitive impairment in patients with dementia and other neurological and psychiatric disorders. Although the Spanish-language version of the ACE-III has already been validated in Spain, it is yet to be validated in Latin America. The aim of this study was to validate the ACE-III test in an Argentinean and Chilean population. METHODS: ACE-III was administered to 70 patients with Alzheimer disease, 31 patients with behavioural variant frontotemporal dementia, and a control group of 139 healthy volunteers. Participants were recruited at centres in both countries. RESULTS: The Spanish-language version of ACE-III was found to have good internal consistency (Cronbach's alpha = 0.87). We found significant differences in total ACE-III scores between patients with Alzheimer disease and controls (p < .05) and between patients with Alzheimer disease and bvFTD (p < .05). With a cut-off point of 86, 98.6% of AD patients, 83.9% of behavioural variant frontotemporal dementia patients, and 84.2% of controls were correctly classified. CONCLUSIONS: This study shows that the Spanish-language version of ACE-III continues to be an effective tool for detecting cognitive dysfunction in patients with dementia

Argentinian/Chilean validation of the Spanish-language version of Addenbrooke's Cognitive Examination III for diagnosing dementia. / Validación argentino-chilena de la versión en español del test Addenbrooke's Cognitive Examination III para el diagnóstico de demencia.

BACKGROUND: The Addenbrooke's Cognitive Examination III (ACE-III), an adaptation of the ACE cognitive screening test, has been demonstrated to have high sensitivity and specificity in detecting cognitive impairment in patients with dementia and other neurological and psychiatric disorders. Although the Spanish-language version of the ACE-III has already been validated in Spain, it is yet to be validated in Latin America. The aim of this study was to validate the ACE-III test in an Argentinean and Chilean population. METHODS: ACE-III was administered to 70 patients with Alzheimer disease, 31 patients with behavioural variant frontotemporal dementia, and a control group of 139 healthy volunteers. Participants were recruited at centres in both countries. RESULTS: The Spanish-language version of ACE-III was found to have good internal consistency (Cronbach's alpha=0.87). We found significant differences in total ACE-III scores between patients with Alzheimer disease and controls (p< .05) and between patients with Alzheimer disease and bvFTD (p< .05). With a cut-off point of 86, 98.6% of AD patients, 83.9% of behavioural variant frontotemporal dementia patients, and 84.2% of controls were correctly classified. CONCLUSIONS: This study shows that the Spanish-language version of ACE-III continues to be an effective tool for detecting cognitive dysfunction in patients with dementia.

Utility of the INECO frontal screening (IFS) in the detection of executive dysfunction in patients with relapsing-remitting multiple sclerosis (RRMS).

Several studies have reported that about 65 % of patients with relapsing-remitting multiple sclerosis (RRMS) suffer from cognitive impairment, with executive dysfunction being the most frequently described. Even if several executive screening tests have been designed to specifically detect executive deficits, few studies have investigated their ability to tackle such dysfunction particularly in multiple sclerosis (MS). The aim of the present study was to evaluate the sensitivity and specificity of the INECO frontal screening (IFS) in the detection of executive dysfunction in patients with relapsing-remitting MS (RRMS). 54 patients with RRMS were included in the study. 34 presented executive dysfunction while 20 did not. 32 control subjects matched for age, sex, and educational level were also included. All were evaluated with the IFS and with a battery of classical executive tests. A patient was considered to have executive dysfunction if he/she scored a one and a half standard deviation below the control mean in at least one of the classical executive tests. Sensitivity and specificity of the IFS in its ability to detect executive dysfunction in MS was analyzed. Using a cut-off of 25.5 points, sensitivity of the IFS was 73.53 %, and specificity 78.13 % in differentiating controls from MS patients with executive dysfunction. The IFS showed excellent concurrent validity with executive tasks. The IFS can be considered a brief, easy-to-administer, cost-less tool for the detection of executive dysfunction in patients with RRMS.

The relationship between executive functions and fluid intelligence in Parkinson's disease.

BACKGROUND: We recently demonstrated that decline in fluid intelligence is a substantial contributor to frontal deficits. For some classical 'executive' tasks, such as the Wisconsin Card Sorting Test (WCST) and Verbal Fluency, frontal deficits were entirely explained by fluid intelligence. However, on a second set of frontal tasks, deficits remained even after statistically controlling for this factor. These tasks included tests of theory of mind and multitasking. As frontal dysfunction is the most frequent cognitive deficit observed in early Parkinson's disease (PD), the present study aimed to determine the role of fluid intelligence in such deficits. METHOD: We assessed patients with PD (n=32) and control subjects (n=22) with the aforementioned frontal tests and with a test of fluid intelligence. Group performance was compared and fluid intelligence was introduced as a covariate to determine its role in frontal deficits shown by PD patients. RESULTS: In line with our previous results, scores on the WCST and Verbal Fluency were closely linked to fluid intelligence. Significant patient-control differences were eliminated or at least substantially reduced once fluid intelligence was introduced as a covariate. However, for tasks of theory of mind and multitasking, deficits remained even after fluid intelligence was statistically controlled. CONCLUSIONS: The present results suggest that clinical assessment of neuropsychological deficits in PD should include tests of fluid intelligence, together with one or more specific tasks that allow for the assessment of residual frontal deficits associated with theory of mind and multitasking.

Validación de la versión en español del Addenbrooke's Cognitive Examination-Revisado (ACE-R) / Validation of the Spanish Version of the Addenbrooke's Cognitive Examination-Revised (ACE-R)

Introducción: El Addenbrooke's Cognitive Examination-Revisado (ACE-R) es una actualización del test de cribado ACE, cuya versión en inglés ha demostrado una alta sensibilidad y especificidad para detectar disfunción cognitiva en pacientes con demencia. La versión original del ACE ya ha sido adaptada y validada en castellano. El objetivo del presente estudio fue adaptar y validar en una población argentina la versión revisada del mismo. Métodos: Un grupo de pacientes con enfermedad de Alzheimer (EA) y pacientes con la variante conductual de la demencia frontotemporal (vcDFT) apareados por edad, sexo y años de educación y un grupo control fueron evaluados con la versión en español del ACE-R. La severidad de la demencia fue medida con el Clinical Dementia Rating Scale (CDR), incluyéndose únicamente pacientes en los estadios tempranos de ambas afecciones. La versión en inglés del ACE-R fue traducida al español y luego retraducida al inglés por dos expertos independientes ciegos a la versión original. Resultados: La fiabilidad interna fue alta (alfa de Cronbach=0,89). La validez concurrente, determinada por la correlación entre el ACE-R y el CDR, fue estadísticamente significativa (p<0,001) y la concordancia entre evaluadores fue excelente (kappa de Cohen=0,98). Los sujetos control obtuvieron puntajes estadísticamente superiores a los pacientes con EA y vcDFT en la mayoría de los subdominios del ACE-R, encontrándose diferencias significativas entre ambos grupos de demencia. Con un puntaje de corte de 85 puntos, la sensibilidad fue del 97,5% y la especificidad del 88,5%, con un cociente de probabilidades de 99,3:1 para la detección de demencia. El ACE-R presentó una sensibilidad más elevada que el MMSE para la detección de demencia. Conclusiones: La versión en español del ACE-R es una herramienta breve y válida para la detección temprana del déficit cognitivo asociados a demencia y ha demostrado ser de utilidad para la diferenciación entre AD y vcDFT (AU)

Background: The Addenbrooke's Cognitive Examination Revised (ACE-R) is an improved version of the earlier brief screening test which has been validated in English with high sensitivity and specificity to detect cognitive dysfunction. The aim of this study was to validate the Spanish version of the ACE-R in an Argentine population. Methods: A group of patients with Alzheimer Disease (AD) and patients with behavioural variant Frontotemporal Dementia (bvFTD) paired by age, sex, and years of education with healthy controls were assessed using the ACE-R. Stage of dementia was measured with the Clinical Dementia Rating Scale (CDR). The English version of the ACE-R was first translated into Spanish and then back-translated into English by two blind independent experts. Results: Internal reliability was very good (Cronbach's alpha=0.89). Concurrent validity, determined by the correlation between total ACE-R and CDR was significant (P<.001) and inter-rater reliability was excellent (Cohen's kappa=0.98). Controls significantly outperformed AD and bvFTD patients on most subdomains of the ACE-R, with significant differences between the dementia groups. With a cut-off score of 85 points, sensitivity was 97.5% and specificity was 88.5%, with a likelihood ratio of 99.3 for the detection of dementia. The ACE-R showed higher sensitivity than the MMSE for the detection of dementia. Conclusions: The Spanish version of the ACE-R is a brief yet reliable screening tool for the detection of early cognitive impairment and has shown to discriminate between bvFTD and AD (AU)

Validation of the Spanish Version of the Addenbrooke's Cognitive Examination-Revised (ACE-R).

BACKGROUND: The Addenbrooke's Cognitive Examination Revised (ACE-R) is an improved version of the earlier brief screening test which has been validated in English with high sensitivity and specificity to detect cognitive dysfunction. The aim of this study was to validate the Spanish version of the ACE-R in an Argentine population. METHODS: A group of patients with Alzheimer Disease (AD) and patients with behavioural variant Frontotemporal Dementia (bvFTD) paired by age, sex, and years of education with healthy controls were assessed using the ACE-R. Stage of dementia was measured with the Clinical Dementia Rating Scale (CDR). The English version of the ACE-R was first translated into Spanish and then back-translated into English by two blind independent experts. RESULTS: Internal reliability was very good (Cronbach's alpha=0.89). Concurrent validity, determined by the correlation between total ACE-R and CDR was significant (P<.001) and inter-rater reliability was excellent (Cohen's kappa=0.98). Controls significantly outperformed AD and bvFTD patients on most subdomains of the ACE-R, with significant differences between the dementia groups. With a cut-off score of 85 points, sensitivity was 97.5% and specificity was 88.5%, with a likelihood ratio of 99.3 for the detection of dementia. The ACE-R showed higher sensitivity than the MMSE for the detection of dementia. CONCLUSIONS: The Spanish version of the ACE-R is a brief yet reliable screening tool for the detection of early cognitive impairment and has shown to discriminate between bvFTD and AD.

Decision making in euthymic bipolar I and bipolar II disorders.

BACKGROUND: The main aim of this study was to compare a large population of patients with bipolar disorder (BD) types I and II strictly defined as euthymic with healthy controls on measures of decision making. An additional aim was to compare performance on a decision-making task between patients with and without a history of suicide attempt. METHOD: Eighty-five euthymic patients with BD-I or BD-II and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention and executive functions, and a decision-making paradigm (the Iowa Gambling Task, IGT). RESULTS: Both groups of patients had worse performance than healthy controls on measures of verbal memory, attention and executive function. No significant differences were found between BD-I, BD-II and healthy controls on measures of decision making. By contrast, patients with a history of suicide attempt had lower performance in the IGT than patients without a history of suicide attempt. CONCLUSIONS: Patients with euthymic BD-I and BD-II had intact decision-making abilities, suggesting that this does not represent a reliable trait marker of the disorder. In addition, our results provide further evidence of an association between impairments in decision making and vulnerability to suicidal behavior.

[Differentiating early dementia from major depression with the Spanish version of the Addenbrooke's Cognitive Examination]. / Diferenciación entre demencias en estadio inicialy depresión utilizando la versión españoladel Addenbrooke's Cognitive Examination.

INTRODUCTION: In clinical practice it is often difficult to establish whether cognitive impairment is secondary to an affective disorder or a dementing process. AIM: To describe the cognitive performance on the Spanish version of the Addenbrooke's Cognitive Examination (ACE) of patients with early dementia and depression. SUBJECTS AND METHODS: 77 patients with early dementia (53 Alzheimer disease; 24 frontotemporal dementia), 17 patients with major depression and 54 healthy volunteers were tested with the Spanish version of the ACE. RESULTS: Alzheimer disease and frontotemporal dementia groups were significantly lower than the control group and the major depression group. When the major depression group was compared with the control group no significant differences were found. CONCLUSIONS: The cognitive performance in the ACE is different in patients with early dementia and patient with depression.

Diferenciación entre demencias en estadio inicial y depresión utilizando la versión española del Addenbrooke’s Cognitive Examination / Differentiating early dementia from major depression with the Spanish version of the addenbrooke’s cognitive examination

La diferenciación entre cuadros demenciales iniciales y la expresión cognitiva de los trastornos anímicoses fundamental en la práctica clínica, tanto de especialistas en trastornos cognitivos como en la de médicos generalistas. Objetivo. Investigar el perfil cognitivo en la versión en español del test de cribado cognitivo Addenbrooke’s Cognitive Examination (ACE) en pacientes con demencias incipientes y depresión mayor. Sujetos y métodos. Se evaluó con el ACE a 77 pacientes con demencias en estadios iniciales (53 con demencia tipo Alzheimer y 24 con demencia frontotemporal), 17 pacientes con criterios de depresión mayor y 54 controles normales. Resultados. Los grupos de demencias incipientes registraron una diferencia estadísticamente significativa, no sólo en relación con el grupo control, sino también con el grupo de trastorno depresivo. Cuando el grupo de depresión se comparó con el grupo control, no se observaron diferencias significativas. Conclusiones. La versión en español del ACE es capaz de diferenciar los cambios cognitivos observados en trastornos anímicos de los que se encuentran en las demencias incipientes

In clinical practice it is often difficult to establish whether cognitive impairment is secondary to anaffective disorder or a dementing process. Aim. To describe the cognitive performance on the Spanish version of the Addenbrooke’s Cognitive Examination (ACE) of patients with early dementia and depression. Subjects and methods. 77 patients with early dementia (53 Alzheimer disease; 24 frontotemporal dementia), 17 patients with major depression and 54 healthy volunteers were tested with the Spanish version of the ACE. Results. Alzheimer disease and frontotemporal dementia groups were significantly lower than the control group and the major depression group. When the major depression group was compared with the control group no significant differences were found. Conclusions. The cognitive performance in the ACE isdifferent in patients with early dementia and patient with depression

Cognitive deficits in multiple sclerosis correlate with changes in fronto-subcortical tracts.

Cognitive function and diffusion tensor imaging were assessed in a group of 12 patients with early relapsing-remitting multiple sclerosis (disease duration

[Validity of the Spanish version of the Addenbrooke's Cognitive Examination for the diagnosis of dementia and to differentiate Alzheimer's disease and frontotemporal dementia]. / El Addenbrooke's Cognitive Examination en español para el diagnóstico de demencia y para la diferenciación entre enfermedad de Alzheimer y demencia frontotemporal.

INTRODUCTION: The Addenbrooke's Cognitive Examination (ACE) is a brief bedside test battery to detect mild dementia and differentiate frontotemporal dementia (FTD) from Alzheimer's disease (AD). AIM: To validate the ACE in Spanish. PATIENTS AND METHODS: The study evaluated the Spanish version of ACE on 128 subjects consisting in two groups a patient group (n = 76) and a control subjects group (n = 52). The patient group was divided in AD (n = 54) based on the NINCDS-ADRDA criteria and FTD (n = 22) based on the Lund y Manchester criteria. All patients underwent clinical, neuropsychological, radiologic (MRI, CT, and SPECT), and laboratory evaluations. Group's differences were evaluated using ANOVA. The internal consistency of the Spanish version of the ACE was measured using the Cronbach's alpha coefficient. The discriminative capability of the Spanish version of the ACE was examined by the receiver operating characteristic (ROC) analysis. RESULTS: The cut-off score of 86 showed a sensitivity of 92% (CI 95% = 83.6-97.0) and a specificity of 96.2% (CI 95% = 86.8-99.4). The ROC curve showed higher sensitivity and specificity of the ACE than the Mini-Mental State Examination in discriminating the dementia and control group. The VLOM ratio (verbal fluency + language)/(orientation + memory) of < 1.82 discriminated for FTD and > 4.87 discriminated for AD. CONCLUSION: The Spanish version of ACE is a brief and reliable instrument for early detection of dementia in highly educated people and offers a simple objective index to differentiate AD and FTD. More studies in less educated people are warranted.

Impairments of social cognition and decision making in Alzheimer's disease.

OBJECTIVE: To investigate the nature of deficits in social cognition and real-life decision making in a group of patients with Alzheimer's disease (AD). DESIGN: A comprehensive neuropsychological and psychiatric assessment, including the Moral Judgment Interview and the Bechara's Card Test, was carried out in 25 patients with AD and 20 age-comparable normal controls. SETTING: Outpatient clinic. RESULTS: AD patients had significantly lower scores in the Moral Judgment Interview and obtained significantly less earnings in the card test when compared to the normal control group. The Moral Judgment Interview score correlated significantly with Raven's Progressive Matrices and Block Design, whereas the card test correlated significantly with both the Benton Visual Retention Test and the Buschke Selective Reminding Test. No significant correlations were observed between the experimental tasks and the psychiatric variables. CONCLUSIONS: AD patients demonstrated significant deficits on tasks assessing social cognition and real-life decision making. These impairments correlated with deficits on specific neuropsychological tasks, but not with behavioral problems frequently found in AD patients.